<div align="center">
	<div>
		
			<table width="100%" border="0">
				<tbody><tr>
					<td width="20%"><strong>Nomor Surat</strong></td>
					<td width="80%"><i id="tpl_roq_no" ></i>
&nbsp;*</td>
				</tr>
				<tr>
					<td><strong>Tanggal Surat</strong></td>
					<td><i id="tpl_roq_date"></i>
&nbsp;*</td>
				</tr>
								<tr>
					<td><strong>Cabang Afiliasi</strong></td>
					<td>
					  <i id="tpl_id_afiliasi"></i>
					</td>
				  </tr>
							
			</tbody></table>
			
			<div style="padding:4px;border-top:1px dotted #333; border-bottom:1px dotted #333; margin-top:5px; margin-bottom:5px;">
				<table width="100%">
					<tbody><tr>
						<td width="50%" valign="top">
							<table>
								<tbody><tr>
									<td><label for="roq_to">To</label></td>
									<td><i id="tpl_roq_to" ></i>
</td>
								</tr>
								<tr>
									<td><label for="to_attn">Attn</label></td>
									<td><i id="tpl_to_attn" ></i>
</td>
								</tr>
								<tr>
									<td><label for="to_address">Address</label></td>
									<td><i id="tpl_to_address" ></i>
</td>
								</tr>
							
								<tr>
									<td><label for="to_phone">Tel.</label></td>
									<td><i id="tpl_to_phone"></i>
</td>
								</tr>
								<tr>
									<td><label for="to_fax">Fax.</label></td>
									<td><i id="tpl_to_fax" ></i>
</td>
								</tr>
								<tr>
									<td><label for="to_email">Email</label></td>
									<td><i id="tpl_to_email" ></i>
</td>
								</tr>
							</tbody></table>
						</td>
						<td width="50%" valign="top">
							<table>
								<tbody><tr>
									<td><label for="roq_from">From</label></td>
									<td><i id="tpl_roq_from" ></i>
</td>
								</tr>
								<tr>
									<td><label for="from_attn">Attn</label></td>
									<td><i id="tpl_from_attn" ></i>
</td>
								</tr>
								<tr>
									<td><label for="from_address">Address</label></td>
									<td><i id="tpl_from_address" ></i>
</td>
								</tr>
							
								<tr>
									<td><label for="from_phone">Tel.</label></td>
									<td><i id="tpl_from_phone" ></i>
</td>
								</tr>
								<tr>
									<td><label for="from_fax">Fax.</label></td>
									<td><i id="tpl_from_fax" ></i>
</td>
								</tr>
								<tr>
									<td><label for="from_email">Email</label></td>
									<td><i id="tpl_from_email" ></i>
</td>
								</tr>
							</tbody></table>
						</td>
					</tr>
				</tbody></table>
			</div>
				
			<table width="100%" border="0">
				<tbody><tr>
					<td width="20%"><label for="subject">Subject</label></td>
					<td width="80%"><i id="tpl_subject" ></i>
</td>
				</tr>
				<tr>
					<td><label for="dear_name">Nama</label></td>
					<td><i id="tpl_dear_name" ></i>
</td>
				</tr>
				<tr>
					<td><label for="soi_shg">Subject of Inspection</label></td>
					<td>
						<i id="tpl_subject_oi"></i>
					</td>
				</tr>
				<tr>
					<td><label for="dog_machine_heavy">Description of Goods</label></td>
					<td><i id="tpl_description_og"></i></td>
				</tr>
			</tbody></table>
			
			<div style="padding:4px;border-top:1px dotted #333;border-bottom:1px dotted #333; margin-top:5px; margin-bottom:5px;">
				<table width="100%">
					<tbody><tr>
						<td width="50%" valign="top">
							<table>
								<tbody><tr>
									<td colspan="2"><strong>Importer</strong></td>
								</tr>
								<tr>
									<td><label for="imp_name">Company Name</label></td>
									<td>
										<i id="tpl_imp_name" ></i>	
									</td>
								</tr>
								<tr>
									<td><label for="imp_attn">Attn</label></td>
									<td><i id="tpl_imp_attn" ></i>
</td>
								</tr>
								<tr>
									<td><label for="imp_address">Address</label></td>
									<td><i id="tpl_imp_address" ></i>
</td>
								</tr>
								 
								<tr>
									<td><label for="imp_tel">Tel.</label></td>
									<td><i id="tpl_imp_tel" ></i>
</td>
								</tr>
								<tr>
									<td><label for="imp_fax">Fax.</label></td>
									<td><i id="tpl_imp_fax" ></i>
</td>
								</tr>
								<tr>
									<td><label for="imp_email">Email</label></td>
									<td><i id="tpl_imp_email" ></i>
</td>
								</tr>
							</tbody></table>
						</td>
						<td width="50%" valign="top">
							<table>
								<tbody><tr>
									<td colspan="2"><strong>Exporter</strong></td>
								</tr>
								<tr>
									<td><label for="exp_name">Company Name</label></td>
									<td><i id="tpl_exp_name" ></i>
</td>
								</tr>
								<tr>
									<td><label for="exp_attn">Attn</label></td>
									<td><i id="tpl_exp_attn" ></i>
</td>
								</tr>
								<tr>
									<td><label for="exp_address">Address</label></td>
									<td><i id="tpl_exp_address" ></i>
</td>
								</tr>
								<tr>
									<td><label for="exp_tel">Tel.</label></td>
									<td><i id="tpl_exp_tel" ></i>
</td>
								</tr>
								<tr>
									<td><label for="exp_fax">Fax.</label></td>
									<td><i id="tpl_exp_fax" ></i>
</td>
								</tr>
								<tr>
									<td><label for="exp_email">Email</label></td>
									<td><i id="tpl_exp_email" ></i>
</td>
								</tr>

							</tbody></table>
						</td>
					</tr>
				</tbody></table>
			</div>
			
			<table width="100%" border="0">
				<tbody><tr>
					<td width="20%"><label for="place_oi">Place of Inspection</label></td>
					<td width="80%"><i id="tpl_place_oi" ></i>
</td>
				</tr>
				<tr>
					<td><label for="date_oi">Date of Inspection</label></td>
					<td><i id="tpl_date_oi"></i>
</td>
				</tr>
			</tbody></table>
			
			<div style="padding:4px;border-top:1px dotted #333;border-bottom:1px dotted #333; margin-top:5px; margin-bottom:5px;">
				<h2>References</h2>
				<table width="99%">
					<tbody><tr>
						<td width="265px"><label for="ref_ibl_no">Industrial Business Lisence No</label></td>
						<td><i id="tpl_ref_ibl_no" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_ip_no">Import Permit No</label></td>
						<td><i id="tpl_ref_ip_no" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_id_no">Importer Identification No</label></td>
						<td><i id="tpl_ref_id_no" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_npwp">NPWP</label></td>
						<td><i id="tpl_ref_npwp" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_inv_no">Invoice No</label></td>
						<td><i id="tpl_ref_inv_no" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_dl_year">Declaration Letter for Year of Manufacture</label></td>
						<td><i id="tpl_ref_dl_year" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_tbl_no">Trading Business Lisence No</label></td>
						<td><i id="tpl_ref_tbl_no" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_crl">Company Registration Lisence</label></td>
						<td><i id="tpl_ref_crl" ></i>
</td>
					</tr>
					<tr>
						<td><label for="ref_cin">Custom Identity Number</label></td>
						<td><i id="tpl_ref_cin" ></i>
</td>
					</tr>
				</tbody></table>
			</div>
			
			<div style="padding:4px; margin-top:5px; margin-bottom:5px;">
				<table width="100%">
					<tbody><tr>
						<td width="20%"><label for="reg_name">Regards, </label></td>
						<td width="80%"><i id="tpl_reg_name" ></i>
</td>
					</tr>
					<tr>
						<td><label for="reg_applicant">Applicant's Name</label></td>
						<td><i id="tpl_reg_applicant" ></i>
</td>
					</tr>
				</tbody></table>
			</div>		
	</div>
</div>